Healthcare from the perspective of a clinician encompassing both the capture of the clinical viewpoint as well as the technology to help clinicians capture knowledge at the point of care
The thoughts expressed are my own and do not necessarily represent those of Nuance

Monday, January 26, 2015

There is no known medical condition that enables an individual to predict the future. While such an ability would be extremely useful for myriad reasons, we have, instead, learned to hone and leverage our analytic skills to deduce what might occur, relying on the data we cull and parse to help forecast the future. So, when it comes to predicting the year ahead, we should consider the one we just had.

Regardless of which side of the exam table you sit, we’re all healthcare consumers

Consumer technology is often a good indicator of what type of capabilities and functionalities might be in store for health IT. This past year, we saw major players in the tech space announce their forays into healthcare. While this will not be without its challenges, it does not diminish the underlying fact that there is a need and want for better technology in healthcare— regardless of whether you are a patient looking to effectively manage your weight or a physician struggling to juggle patient care and administrative duties.

In the last year, we saw a wave of next-generation wearable devices flood the market, and as a result, we, as patient consumers, now have streamlined access to information such as our daily step count and average heart-rate on our watches. We know that ease-of-use, understandability, and some level of gameification:

“Congratulations! You’ve reached your target heart rate today!”

are vital to maintaining engagement.

I believe this is the beginning of something much larger, a groundswell movement that will result in patients wanting more information about their health data, and, more importantly, craving a better understanding of what all these numbers actually mean and how to positively impact them. Achieving this level of engagement demands a simpler intelligent interface that doesn’t require a learning curve, but is one that consumers can just use. Clever user interface designs can only go so far, particularly given the small visual real estate available on wearable devices, and the addition of capabilities such as intelligent voice assistants will be an integral part of this explosion of personal health management.

Having a heart-to-heart about your heart

Technology holds the potential to create clinical synergy, bringing patient consumers (who have become professional health IT consumers, or health prosumers) better intelligence about their personal health data and outlining the proactive measures they can take to become better partners in their own health. The average patient consumer may not have a reaction to the phrase

“Your Protime this week is 3.3,” but for someone with a heart condition, this number is very important and indicates how fast her blood is clotting. The data, while extremely useful to a clinician, is only helpful to the patient if she understands what it means and how she can take the right actions as a result.

The future is about patients managing their own care and working alongside clinicians to drive better outcomes. To the woman who has a Protime of 3.3, access to these results supplemented with clinical guidelines would mean that she wouldn’t need to wait for her physician to call with diet recommendations, she would know her blood is clotting too slowly and that she might have an inadequate protein consumption or might need to increase her vitamin K intake. If the number required that her Coumadin dosage be adjusted, this would be the point where her physician would reach out to her to discuss.

Although a basic example, it is one that has endless permutations when it comes to building a more engaged patient population. There is no one more invested in your health than you, and the person who cares the next most about keeping you well, is your physician. I believe that clinical synergy will be driven by both patients, who want to actively manage their chronic conditions and take meaningful preventative care measures, and physicians who want to empower their patients to better understand how the choices they make have significant health implications. Technology is the connective fiber that can enable the transmission of this important data, and help translate it into wisdom. And that truly is the crux—the data flowing between patient and physician must be relevant and meaningful. That ability for technology to determine the relevancy of health data information is just around the corner and soon our wearables will be able to notify our health information data that deviates from our personal “normal” results.

Approximately 75 percent of U.S. healthcare expenditure is related to chronic care management, imagine the impact this level of clinical synergy will have on driving a healthier population while reducing cost. I’m ready, are you?

Tuesday, January 20, 2015

As a physician and a CMIO, I’m forever seeking the latest technology offerings that might help us solve some of the very complex problems that exist in healthcare. With that goal in mind, I set out across the CES 2015 showroom floor, seeking the best in health innovation.

While it was interesting to see all the fitness and consumer health apps, I found myself spending extra time looking at non-healthcare related technologies, drawn in one direction or the other based on the “oohs” and “ahhs” of crowds marveling at incredible and unfettered innovation. I made countless stops along the way, and spoke to many different creators about the potential healthcare implications of their products, and I quickly realized that the future of health IT innovation will be a combination of various consumer technologies that are carefully sutured together.

Internet of Healthcare Things (IoHCT)

The interconnectivity of devices has been a growing trend in the consumer world, but it is one that has not really made its foray into healthcare. When it does, the potential will be astounding. I spoke with La Crosse Technology,

They collect data from weather systems, such as temperature, humidity, etc. They have developed the ability to leverage this data to adjust home heating and cooling systems according to the current weather conditions. Practical and money-saving for sure, but it is easy to extrapolate the benefits of such technology to patient consumers.

Imagine the impact this could have for someone suffering from chronic respiratory issues or severe asthma: they could receive guidance on what is going on outside and perhaps take extra medication to cope with poor air quality.

Additionally, such data could be used to send important reminders to help patients better cope with their medical issues, for instance, a virtual assistant that says “Heavy snow is on the way for the next three days, and I noticed your drug supply was down to two days, you should refill today so you don’t run out while the weather is bad and traveling is difficult.”

Although there were many players in the home-monitoring space, I found this one compelling as it was easy to install and designed to learn, adapting to daily occurrences and routines as opposed to being programed. Imagine the value of setting this device up in the home of an elderly patient or loved one and using it not for security purposes, but for peace-of-mind, to make sure there is activity and movement and to learn of a fall or worsening condition more quickly.

Because the system is able to learn, it can discern the difference between a dog or cat roaming about the house and a person, so if there was an incident, a pet won’t “trick” the system into thinking the individual is actually walking about the room. While personal alerts are helpful if the individual is conscious and is wearing a medical alert device, a system such as this could help identify more severe life-threatening health conditions, and, with an intelligent virtual assistant, could ask residents if they are okay and call for help, if they get a negative or no response.

A Modern-day Techie Odysseus

Those familiar with the story of Odysseus know that he spent seven years sailing the seas trying to return to his homeland, Ithaca. What started out as a point A to point B trip, became a journey that forced him to see things differently. He was drawn in by all sorts of alluring (and not so alluring) options along the way, and when he finally returned home, he did so a wiser man. Meandering through the labyrinth-like CES showroom floor, I saw everything from robots that attach to windows
Solving that challenging problem of dirty windows on the outside

Technology that allows users to control devices via subtle muscle movement from behind their ears.

A Nod to 3-D Printing

3D printing is taking off and I saw multiple exciting innovations of the technology on the show floor that included developments around materials and the ability to print metals and food. As you can see from this Geek Beat clip we are heading for a reality of the Star Trek Replicator

Health and Fitness Apps Get a MakeOver

As my colleague Rebecca Paquette pointed out in her post on CES we are getting people to talk to things more naturally.

Chances are if you’re into staying fit, you’re into tracking all of the data that goes into keeping you happy and healthy. But tracking that data shouldn’t be a workout unto itself. The amount of time we spend logging meals, activity and sleep could be much better used burning more calories, or, if you’re like me, getting more shut eye (I forget to log it, then scramble to get it in before I fall asleep).

This consumer health prototype app on the Samsung Gear S from Nuance turns the process of interacting with these devices on its head as featured in this interview at CESLive

But the best thing about wandering the show is that it makes you see things differently, helps you think about things in a new way. It’s about pushing the limits, finding new use cases, new possible technology partnerships to create an even more robust, more powerful solution to address what people need.

Healthcare impacts many different types of people, from patients and clinicians, to administrators, coders and compliance officers— just to name a few. The common denominator, regardless of who you are, is that we all seek the best possible health outcomes. Having the opportunity to not only see, but experience, all different types of technology with untapped healthcare potential was incredible. It wasn’t about finding the health-specific applications and devices that would magically solve any one challenge, but about seeing the copious options available to consumers en masse, and talking with innovators about the potential cross-over and blending of technologies to advance healthcare today and in the future

Tuesday, January 6, 2015

This year I have the privilege of attending CES2015 in Las Vegas - for those of you who have not been before its big..even by Las Vegas standards.

CES attracts 150,000 visitors (all looking for the same cabs so I’m willing to bet that Uber is not going to work as well), occupies 2,000,000 sq ft of space (35 football fields - American or the rest of the world soccer) and includes 3,500 companies

This year the DigitalHealthCES meeting runs concurrently and I believe is in its 4th year. Further evidence of the merger of health, consumer and the engaged patient equipped with mobile technology and wearables.

Wearables are front and center and John cites the Amstrip company with a band aid style monitoring concept. I expect clothing and in particular sports to lead this charge with the initial interest in optimizing training and athletic performance as we saw from the World Cup last year and the miCoach system from Adidas that was in use by the winners Germany.

Needless to say others are joining the fray with clothing brands such as Asics, Under Armour and Ralph Lauren now offering clothes to monitor all sorts of parameters

This year may see the emergence of more from the Internet of Things (IoT) - or the new term the Internet of Everything (IoE).

Everything connected and controlled through a consumer friendly hub which will include the wearable and monitoring concepts.

This is as simple as ceiling fans and cooling systems and thermostats but with healthcare making this even more interesting and the learning potential of these intelligent systems and their Artificial Intelligence offering insights into our lives to help turn unhealthy behaviors and activities into healthy choices.

So much of our healthcare expenditure is related to chronic care management, imagine the impact this level of synergy and motivation will have on driving a healthier population while reducing cost.